Many mistakenly believe that anyone who intentionally harms their own body is trying to end their life.  The legal and mental health systems are challenged by a lack of clarity about suicidal behavior.  Police stations, jails and some psychiatric facilities will often put someone on ‘suicide watch’ for self harming behaviors.

Although some people injure themselves in a suicide attempt, the act of self- injury is often something quite different than an attempt to end life.  To understand self-injury it is essential to make a distinction between the act of self-injury and a suicide attempt.

Suicide is defined as an intentional act of killing yourself.  With a suicide attempt a person’s intention is to end their life, with both intent to end life and knowledge of medical lethality predictors of the outcome.  A self-injurious act must occur with at least some intent to die as a result of the act in order to be considered a suicide attempt.  This intent may not be explicit to be considered a suicide attempt.  Examples of an inferred attempt include an overdose that is discovered or pulling the trigger on a gun, but the gun failing to fire. There does not have to be any injury or harm, just the potential for injury.

In contrast, self-injury is deliberate, direct destruction of body tissue resulting in tissue damage. Cutting, a common form of self injury, is often not an attempt at suicide.  Rather than attempting to end their lives, people who self-harm are surviving and managing intolerable and emotionally painful lives.  They don’t necessarily want to die, nor do they often see happiness as attainable.  They just want to stop feeling miserable.

When someone experiences the numbness of repeated trauma, the tissue damage, physical pain and blood from injuring yourself can be a reminder of life. Behaviors such as burning and cutting help to control emotion and obtain help from an indifferent or punishing environment.

The difference that emerges between suicide attempts and self-injury is in intention and lethality. In one study non-suicidal acts of self-harm were reported as intended to express anger, punish oneself, generate normal feelings and distract oneself.  In contrast, the most often reported intention of suicide attempts was to make others better off.

Self-injury, therefore, can be seen as inadequate solutions to overwhelming, intensely painful emotion.  On the other hand, suicide attempts include self-injurious acts or acts with potential for harm (for example, putting a gun in your mouth) that have an explicit or inferred intent to die as a result of the act.